Category: Apraxia and Dysarthria

Apraxia: Classroom Placement and Amount of Therapy

By Pam Marshalla

Q: My beautiful nearly four-year-old son was diagnosed with verbal apraxia around the age of two. There does not seem to be any other developmental issues of concern. Have you found that an alternative schooling program is better for the preschool aged children with apraxia? If so what type of schooling would you suggest? He currently is enrolled in the public school system and only receives one half-hour of speech therapy three days per week there. We also go to…

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Message to a Panicked Parent With Apraxic Child

By Pam Marshalla

Q: I have a 5-year-old boy suffering with a bad case of verbal apraxia coupled with an SI disorder. I am desperate for intensive PROMPT and oral motor treatment for my boy. Its heart breaking to watch him try so hard and fail to speak. Please help us. You sound like you are panicking — DON’T. You sound like you think that PROMPT and ORAL MOTOR are the only solutions — THEY AREN’T. There are as many ways of helping…

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Goldenhar Syndrome and Reduced Tongue Movement

By Pam Marshalla

Q: Is oral-motor therapy beneficial in treating a child with Goldenhar syndrome with one-sided facial weakness? If you are asking for “proof” of this, no. But your question reveals perhaps a limited understanding about what the term “oral-motor therapy” means. Let me explain… Speech is movement, and whenever part of the speech movement mechanism is impaired, then therapy needs to address that movement impairment. The term “oral-motor techniques” simply refers to any of the myriad ways in which we facilitate…

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When /d/ Is the Only Consonant

By Pam Marshalla

There is a question that arose in a seminar recently that I want to share. I was teaching on apraxia, and using the 23 methods of jaw, lip, and tongue facilitation as the main focus of the class. The question was about a three-year-old boy who had no other consonants but /d/. He was speaking single words of 1-3 syllables, but his productions were limited to CV structure. Thus, telephone would be produced as “deh-duh-doh.” The question the therapist had…

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Initial /h/

By Pam Marshalla

Q: I have a 1st grade student with moderate to severe apraxia who can make the /h/ sound in isolation but cannot co-articulate it. I’ve written the letter /h/ on an index card, and a vowel on another card. I have had him touch the H card and make /h/, and then touch the vowel card and make it. And we have increased the speed as we go but he ends up dropping the /h/ every time. Is there another…

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Down Syndrome

By Pam Marshalla

Q: My son has Down syndrome and possible apraxia. Can you give me advice about this? Many therapists today are labeling children with Down syndrome as apraxia, but this is an incorrect diagnosis. The expressive speech and language problems of children with Down syndrome are the result of dysarthria and cognitive deficit. Dysarthria “A generic label for a group of motor speech disorders caused by weakness, paralysis, slowness, incoordination, or sensory loss in the muscle groups responsible for speech” Brookshire, R. H….

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Piaget on Apraxia

By Pam Marshalla

Q: I have a question regarding some information in your book called Becoming Verbal with Childhood Apraxia. I have found the information in this book to be quite valuable in my work in early intervention. Where can I find more information on Piaget’s four basic stages in the development of imitation skills? I am the only person I know who has abstracted Piaget’s information in this way, and that is why I spelled it out in that book. I originally…

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Assessment of a Lisp

By Pam Marshalla

Q: I am scheduled to see a 14-year-old male with a lisp on /s/. He recently got braces and the dentist told his mother that the child had better see a speech language pathologist if the braces are to help at all. Can you help me organize this diagnosis? Focus on the speech first. You must know exactly what phonemes are affected. Look at ALL of them, not just /s/. Look at all the sibilants, and all other phonemes, especially the…

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Cerebral Palsy and Intelligibility

By Pam Marshalla

Q: My 12-year-old grandson has cerebral palsy. He understands everything at age level but he is very hard to understand. He is getting very little speech help. How can we help him at home? Expressive speech is divided into Consonants, Vowels, Syllables, and Intonation Patterns. Most SLP’s focus on Consonants. I would suggest that you focus on Vowels, Syllables and Inflection instead. In other words, have your grandson practice important words, and instead of focusing on getting the consonants correct,…

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